Laparoscopic versus open management of hiatal hernia in children

Objective: The aim of this study was to evaluate the safety and efficacy of laparoscopic fundoplication and compare it with the open procedure in the management of hiatal hernia (HH) in children. Patients and methods: This comparative study was conducted on 20 patients younger than 18 years who underwent open or laparoscopic fundoplication between June 2006 and December 2014. The patients were followed up for 9–12 months. Results: Among 20 patients there were 17 sliding, one paraesophageal, and two mixed HHs. Laparoscopic surgery (LS) was conducted in 12 patients and open surgery (OS) in eight patients. The operative time was shorter in the OS group (117.6±46.5 min) versus the LS group (168.3±61.2 min). The time to start oral intake and the time to full feeding were shorter in the LS group (2.0±0.8 and 8.5±3.6 days, respectively) versus the OS group (4.2±1.8 and 12.1±9.0 days, respectively). The length of hospital stay was shorter in the LS group (24.3±12.8 days) versus the OS group (56.2±45.7 days). There were no statistically significant differences in sex, age, or body weight between the two groups. One patient died after cardiac surgery. No recurrence was reported. Conclusion: Laparoscopic fundoplication in children is safe and effective and it may be the treatment of choice for HH and gastroesophageal reflux disease in the future.